MEDICARE: VIMARI DE LA CRUZ ARNP, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11012269	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033795760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIMARI DE LA CRUZ ARNP, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1137
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32902-1137
Country	:	US
Telephone Number	:	321-241-6800
Fax Number	:	321-241-6890

Provider Business Practice Location Address
First Line	:	1361 FLORIDA AVE NE APT 2
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32905-2650
Country	:	US
Telephone Number	:	321-241-6800
Fax Number	:	321-241-6890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	06/27/2024

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